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Ethics Complaint

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NEVADA COMMISSION ON ETHICS

ETHICS COMPLAINT NRS 281A.700 to 281A.790

1. SUBJECT OF THE COMPLAINT (person you allege violated provisions of NRS Chapter 281A, the NevadaEthics in Government Law. (Please use a separate form for each individual.)

TITLE OF PUBLIC OFFICE: (Position)

PUBLIC ENTITY: (Name of the entity employing this position)

ADDRESS: CITY, STATE,

ZIP CODE

TELEPHONE: Work: Other: (Home, cell)

EMAIL:

2. Describe the alleged conduct of the public officer or employee (subject) that you believe violated NRS Chapter281A. (Include specific facts and circumstances to support your allegation: times, places, and the nameand position of each person involved.)

Check here if additional pages are attached.

3. Is the alleged conduct currently pending before another administrative, law enforcement or judicial body? If yes,describe:

Nevada Commission on Ethics

Case No. ______For Official Use Only

SubjectNAME:

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4. NRS Chapter 281A requires public officers and employees to hold public office as a public trust and avoid conflictsbetween public duties and private interests. (NRS 281A.020) What provisions of NRS Chapter 281A are relevantto the conduct alleged? Please check all that apply.

*Pursuant to NRS 281A.065, a public officer or employee has a commitment in a private capacity to the following persons/entities:

1. Spouse; domestic partner.2. Household member.3. Family member within 3rd degree of consanguinity/affinity.4. Employer or spouse/domestic partner/household member's employer.5. Substantial and continuing business relationships, i.e. partner, associate, or business entity.6. Substantially similar relationships to those listed above, including close, personal relationships akin to family and fiduciary relationships

to business entities.

Statute Statutory Summary:

NRS 281A.400(1)

Seeking or accepting any gift, service, favor, employment, engagement, emolument or economic opportunity for himself or person to whom he has a commitment in a private capacity which would tend improperly to influence a reasonable person in his position to depart from the faithful and impartial discharge of his public duties.

NRS 281A.400(2) Using his position in government to secure or grant unwarranted privileges, preferences, exemptions or advantages for himself, any business entity in which he has a significant pecuniary interest, or any person to whom he has a commitment in a private capacity.

NRS 281A.400(3) Participating as an agent of government in the negotiation or execution of a contract between the government and himself, any business entity in which he has a significant pecuniary interest or any person to whom he has a commitment in a private capacity.

NRS 281A.400(4) Accepting any salary, retainer, augmentation, expense allowance or other compensation from any private source for himself or any person to whom he has a commitment in a private capacity for the performance of his duties as a public officer or employee.

NRS 281A.400(5) Acquiring, through his public duties or relationships, any information which by law or practice is not at the time available to people generally, and using the information to further the pecuniary interests of himself or any other person or business entity.

NRS 281A.400(6) Suppressing any governmental report or other document because it might tend to affect unfavorably his pecuniary interests or the interests of any person to whom he has a commitment in a private capacity.

NRS 281A.400(7) Using governmental time, property, equipment or other facility to benefit his significant personal or pecuniary interest, or any person to whom he has a commitment in a private capacity. (Some exceptions apply).

NRS 281A.400(8)

A State Legislator using governmental time, property, equipment or other facility for a nongovernmental purpose or for the private

benefit of himself or any other person, or requiring or authorizing a legislative employee, while on duty, to perform personal services

or assist in a private activity. (Some exceptions apply).

NRS 281A.400(9) Attempting to benefit his personal or pecuniary interest or the interests of any person to whom he has a commitment in a privatecapacity through the influence of a subordinate.

NRS 281A.400(10) Seeking other employment or contracts for himself or any person to whom he has a commitment in a private capacity through the use of his official position.

NRS 281A.410

Representing or counseling a private person for compensation on an issue pending before a public agency while employed, or within 1 year after leaving the service of a public agency, including before any state agency of the Executive or Legislative Department. (State and local legislators and part-time public officers and employees may represent/counsel private persons before agencies they do not serve, except local legislators may not represent/counsel private persons before other local agencies within the same county.)

NRS 281A.420(1) Failing to sufficiently disclose his acceptance of a gift or loan, pecuniary interest, commitment in a private capacity to the interest of another person or the nature of any representatiation or counseling provided to a private person for compensation before another agency in the preceeding year that is reasonably affected by an official matter.

NRS 281A.420(3) Failing to abstain from acting on an official matter which is materially affected by his acceptance of a gift or loan, pecuniary interest, or commitment in a private capacity to the interest of another person.

NRS 281A.430 Bidding on or entering into a government contract in which he has a significant pecuniary interest. (Some exceptions apply).

NRS 281A.500 Failing to file or timely file a Nevada Acknowledgment of Ethical Standards for Public Officers form.

NRS 281A.510 Accepting or receiving an improper honorarium.

NRS 281A.520 Requesting or otherwise causing a governmental entity to incur an expense or make an expenditure to support or oppose a ballot question or candidate during the relevant timeframe.

NRS 281A.550 Negotiating or accepting employment from a business or industry regulated by or contracted with former public agency within one year after leaving service of the agency. (Failing to honor the one-year "cooling off" period after leaving public service, exceptions).

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5. YOU MUST SUBMIT EVIDENCE TO SUPPORT YOUR ALLEGATIONS. (NRS 281A.710 through 281A.715.)Attach all documents or items you believe support your allegations, including witness statements, public orprivate records, audio or visual recordings, documents, exhibits, concrete objects, or other forms of proof.

State the total number of additional pages attached (including evidence) _________.

6. Witnesses: Identify persons who have knowledge of the facts and circumstances you have described, as wellas the nature of the testimony the person will provide. Check here if additional pages are attached.

NAME and TITLE: (Person #1)

ADDRESS: CITY, STATE, ZIP

TELEPHONE: Work: Other: (Home, cell)

E-MAIL:

NATURE OF TESTIMONY:

NAME and TITLE: (Person #2)

ADDRESS: CITY, STATE, ZIP

TELEPHONE: Work: Other: (Home, cell)

E-MAIL:

NATURE OF TESTIMONY:

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7. REQUESTER INFORMATION:

YOUR NAME:

YOUR ADDRESS:

CITY, STATE, ZIP:

YOUR TELEPHONE:

Day: Evening: E-MAIL:

Your identity as the Requester will be provided to the Subject if the Commission accepts jurisdiction of this matter, unless: Pursuant to NRS 281A.750, I request that my identity as the requester of this Ethics Complaint remain confidential because (please check appropriate box): I am a public officer or employee who works for the same public body, agency or employer as the subject of

this Ethics Complaint. Provide evidence in the text box below, or as an attachment, of your employment with the same public body, agency or employer.

OR

I can show a reasonable likelihood that disclosure of my identity will subject me or a member of my house-hold to a bona fide threat of physical force or violence. Describe in the text box below, or in an attachment, the facts and circumstances that support a reasonable likelihood of a bona fide threat of physical force or violence.

If the Commission declines to maintain my confidentiality, I wish to:

Withdraw my Complaint OR

Submit the Complaint understanding that the Subject will know my identity as the Requester.

By my signature below, I affirm that the facts set forth in this document and all of its attachments are true and correct to the best of my knowledge and belief. I am willing to provide sworn testimony regarding these allegations. I acknowledge that this Ethics Complaint, the materials submitted in support of the allegations, and the Commission’s investigation are confidential unless and until the Commission’s Review Panel renders a determination. Certain Commission procedings and materials, including the Investigatory File remain confidential pursuant to NRS 281A.750 through 281A.760.

Signature: Date:

Print Name: You may file a Complaint using the Commission’s online form submission at ethics.nv.gov (Preferred) or

You must submit this form bearing your signature to the Executive Director via:

delivery/mail to Nevada Commission on Ethics, 704 W. Nye Lane, Suite 204, Carson City, Nevada, 89703,

email to NCOE@ethics.nv.gov, or fax to (775) 687-1279

A copy of this Complaint will be provided to the Subject. If your request for confidentiality is approved by the Commission, the Complaint will be redacted to protect your identity as the Requester. The Commission may decline to maintain the confidentiality of your identity as the Requester for lack of sufficient evidence of your employment status with the same public body, agency or employer, or proof of a bona fide threat of physical force or violence.